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General NPI Number Information
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NPI Number | 1538295829
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Entity Type | Individual
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Provider Name | GARY DEAN STOVER MA, LP
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Gender | Male
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2121 7TH ST
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City | PARKERSBURG
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State | WV
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Zip | 26101-3803
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Country | US
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Telephone | 304-485-1721
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Fax | 304-485-6710
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Provider Business Mailing Address
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Address Line | 3518 CADILLAC DR
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City | PARKERSBURG
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State | WV
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Zip | 26104-2114
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Country | US
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Telephone | 304-485-5578
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | 873
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License Number State | WV
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